When surgery isn’t the answer

Last week doctors were given new guidance on how to treat men with prostate cancer.

One of the recommendations is keeping men with localised prostate cancer under surveillance rather than giving them an operation which can carry serious side effects.

One man who was faced with having a diagnosis of prostate cancer is Alan Johnson. “I only found out I had prostate cancer after a well man clinic at work,” says Alan, now 61, from Ossett, near Wakefield.

“I had a slightly raised PSA level and thankfully my GP sent me for some tests to be on the safe side and they found some malignant cells.”

The PSA test measures the blood level of PSA, a protein produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer.

Alan, a former engineering manager, was told he would need surgery, but he was worried about the side effects.

“When I got the diagnosis, I was fairly amazed and it felt like a ticking time bomb. The doctor suggested I should get the prostate surgically removed but I was worried about the side effects, so I did a lot of research.

“I was scared about living with something so dangerous. As a rugby fan, the story of Andy Ripley had a profound impact on me. He was a phenomenal athlete, he played for England and the Lions, and he ended up blind and in a wheelchair before he died from prostate cancer.

“I was 53, had just separated from my wife and started seeing someone else and I was really worried about losing my sexual function.”

During his research Alan read about a doctor in London who was carrying out trials of a high intensity focused ultrasound (HIFU) – a minimally invasive treatment that decreases the risk of impotence and incontinence.

The focal therapy, dubbed “the male lumpectomy”, targets only the cancerous cells and leaves the remaining prostate intact, saving the healthy tissue which is lost when the whole prostate is removed.

“They just take the affected part of the prostate away which means if you then need to go on and have further treatment or surgery then you can.”

Alan had an MRI scan either side of the HIFU procedure, and was in and out of University College London Hospital, where the HIFU was performed by Professor Mark Emberton, who was conducting the trials.

“It was a fantastic decision because I’ve experienced none of the side effects and my PSA has been stable now for several years.”

Prostate cancer leads to around 10,000 deaths in the UK every year.

“When I look back, there was no way I needed surgery,” added Alan. “But neither did I want to live with something like cancer in me. There are probably thousands of men who have gone for the surgery route prematurely.

“Unless it’s very advanced, there are alternatives. I came down to London and I was in and out in a day and a night, I didn’t have to spend ages recovering.

“It has given me the best opportunity to live a very normal life, it’s saved my sex life and I wake up every day feeling as good as new.”

Drew Lindon, head of policy and campaigns at Prostate Cancer UK, welcomed the guidelines from the National Institute for Health and Care Excellence (Nice), but is still calling for more research into the condition.

“The brutal truth is that prostate cancer diagnosis and treatment lag behind where they should be, especially compared to conditions such as breast cancer. Not only are there too few treatment options but those which do exist often leave men facing side effects like erectile dysfunction.

“Where a cancer isn’t aggressive many men may in fact be better off working with their doctor to keep a close eye on the condition rather than undergoing treatments.

“It’s good to see Nice setting out a guide to help clinicians talk through all the options that men have available to them, while still preserving treatment as an option.

“Unfortunately, it is still not possible to say with certainty whether a man has an aggressive form of the cancer, or one which will not cause harm in their lifetime. This leaves many men faced with difficult decisions about which route to take.”

DISEASE WITH DEADLY TOLL

Prostate cancer is the most common cancer in men and makes up 26 per cent of all male cancer diagnoses in the UK.

In 2008, 34,335 men were diagnosed and 9,376 died from prostate cancer. This increased to 9,632 deaths in 2010.

Prostate cancer is mainly a disease of older men (aged 65-79) but around 25 per cent of cases occur in men under 65. There is also higher incidence of and mortality from prostate cancer in men of black African-Caribbean origin.

Prostate cancer is usually diagnosed after a blood test in primary care has shown elevated prostate-specific antigen (PSA) levels.

Robert De Niro, Rudy Giuliani, Rupert Murdoch and Colin Powell are among the famous names to have suffered prostate cancer,

For more information visit www.prostatecanceruk.org